This World AIDS day feels different to all others. It has felt like the end of AIDS is in sight for some time now but after 30 years with so much hope and so many false alarms the wise have learned not to get excited by each announcement and slogan. But in the wake of news of declining epidemics and the role of treatment in prevention Michel Sidibe has actually said it, so we can probably safely celebrate that we have turned the corner into the home straight.
But at the same time we have to recognise that the final post – zero new infections, zero deaths and zero discrimination – is still a long way down the straight. Achieving universal access to treatment, care, STI treatment, enabling environments, information and prevention technologies all still lay ahead. Moreover the speed of the progress now more than ever depends on sex workers, drug users and gay men’s access to HIV treatment and care. To labour the racing metaphor, we also need to recognise that some in the race are severely handicapped and facing a course many hurdles and high fences.
Earlier this year I was chatting with a group of sex workers in Ethiopia about cash transfers by mobile phone in other African countries. “It will come to Ethiopia, but when it does we will be the last to benefit from it”, said one woman, more as a statement of fact than an expression of hopelessness or cynicism. And so it is with HIV services. There is plenty of evidence that too often male, female and transgender sex workers continue to be the last on the line for lifesaving medications and prevention technologies despite being the first in the line to be participants in the medical experiments needed to develop them.
Another key difference for me between this World Aids Day and others is the volume of the voice of HIV positive workers. I remember when ICW and GNP+ first began meeting and it was unthinkable for us in the sex work networks to send anyone as an openly positive sex worker. No–one in the dozens of drop-in centres I visited in several countries throughout the 90’s admitted to being positive. By contrast his year I met openly positive sex workers all year as I attended policy meetings and worked on research that included focus groups of female and transgender sex workers. In every country I visited HIV positive workers said that discrimination had significantly diminished, particularly in health care settings. Everyone who needed them had ARVs and awareness of health was good all round.
Not so good was the positive sex workers view that poverty prevents access to the non ARV medications, nutrition, accommodation and rest people living with HIV need. That poverty is inexorably linked to the cycle of fines, bribes, fees and incarceration that are created by criminal laws and misguided anti-trafficking programmes. But that’s another part of the story. Today is a day to be pleased that we can say that in some important ways things are moving in the right direction for sex workers living with HIV.